Vancouver, British Columbia — Rewind to 1981. Jean Carruthers, M.D., was a pediatric ophthalmologist and ophthalmic geneticist, while husband Alastair Carruthers was running a general dermatology practice.
James Alastair Carruthers, M.D. and Jean Carruthers, M.D.
Alastair was accepted for a Mohs surgery fellowship at the University of California, San Francisco, and Jean thought that making the trek from Canada to California was a grand idea.
"Great!" she said. "I'll go and learn about botulinum toxin." "You are going to do what?" Alastair asked.
"Don't worry. It has been in Reader's Digest."
The rest is history.
Although the Carrutherses operate separate practices in the same building in Vancouver, it was the synergy of the husband-and-wife team of cosmetic surgeons that drove the cosmetic success of botulinum toxin.
It was Jean, according to Alastair, who came home from California with the Botox cosmetic idea and, essentially, created a whole new area of subspecialization — the concept of producing improvement through simple treatments.
"It started off with Botox; then in the late '90s we began to get all the new fillers, and nonablative resurfacing developed. These followed the remarkable success of Botox," he says.
But Jean's first meeting in 1982 had nothing to do with the cosmetic use of the toxin. Rather, she worked with Drs. Alan Scott and Art Jampolski at the Smith-Kettlewell Institute for Visual Sciences in San Francisco, using botulinum toxin to straighten misaligned eyes. Dr. Scott had the idea, and Dr. Jampolski devised a means of using electromyography to deliver the toxin, which Dr. Scott was marketing as Oculinum. His company was acquired by Allergan in 1988.
Jean went back to Canada and was a co-investigator in a multicenter National Institutes of Health study to help ensure approval of the therapeutic use of the drug in the United States and Canada.
The realization that botulinum toxin had cosmetic possibilities dawned in 1987, when one of Jean's adult dystonia patients became angry with Jean for not injecting botulinum toxin between her eyes.
"I apologized and said I did not think she was spasming there," Jean says. "She agreed that she was not spasming there, but said, 'Every time you treat me there, I get this beautiful, untroubled expression.'
"That's when the light bulb went off."
Jean approached Alastair with the idea, and together they did a research protocol on botulinum toxin's cosmetic use.
"It took us from 1987 to 1990 to get 30 patients," Jean says. "That is how 'fringe' this idea was."
In 1990, the duo published an abstract. The following year, they presented a paper at the American Society for Dermatologic Surgery meeting.
"The audience was very quiet," Jean says. "After the meeting, a lot of our close friends in the audience came up to us and said they thought, 'Now, there is a crazy idea that will go nowhere.'"
Alastair continued his quest to get the word out among dermatologists. All the while, the Carrutherses had no financial incentive from Allergan to do so. Alastair had approached Allergan in 1992, and the company flew the couple to its Irvine, Calif., headquarters to discuss the cosmetic possibilities. But the board nixed the idea, saying Allergan was not a cosmetic company. That corporate thinking did not change until 1998, according to Alastair.